Abstract

Purpose

While the standard setting during radiofrequency catheter ablation (RFCA) consists of applying low power for long times, a new setting based on high power and short duration (HPSD) has recently been suggested as safer and more effective. Our aim was to compare the electrical and thermal performance of standard vs. HPSD settings, especially to assess the effect of the catheter orientation.

Methods

A 3D computational model was built based on a coupled electric-thermal-flow problem. Standard (20 W–45 s and 30 W–30 s) and HPSD settings (70 W–7 s and 90 W–4 s) were compared. Since the model only included a cardiac tissue fragment, the power values were adjusted to 80% of the clinical values (15, 23, 53 and 69 W). Three catheter-tissue orientations were considered (90°, 45° and 0°). Thermal lesions were assessed by the Arrhenius equation. Safety was assessed by checking the occurrence of steam pops (100 °C in tissue) and thrombus formation (80 °C in blood).

Results

The computed thermal lesions were in close agreement with the experimental data in the literature, in particular with in vivo studies. HPSD created shallower and wider lesions than standard settings, especially with the catheter at 45°. Steam pops occurred earlier with HPSD, regardless of catheter orientation.

Conclusion

HPSD seems to be more effective in cases that need shallow and extensive lesions, especially when the catheter is at 0° or at 45°, as used in pulmonary vein isolation.

中文翻译：

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大功率短时与标准射频心脏消融：基于计算机模型的比较研究

摘要

目的

尽管射频导管消融期间的标准设置（RFCA）包括长时间施加低功率，但最近有人提出了一种基于高功率和短持续时间（HPSD）的新设置，它更安全，更有效。我们的目的是比较标准设置和HPSD设置的电学和热学性能，尤其是评估导管方向的影响。

方法

基于耦合的电热流问题建立了3D计算模型。比较了标准（20 W–45 s和30 W–30 s）和HPSD设置（70 W–7 s和90 W–4 s）。由于模型仅包含心脏组织碎片，因此功率值已调整为临床值的80％（15、23、53和69 W）。考虑了三个导管组织方向（90°，45°和0°）。通过Arrhenius方程评估热损伤。通过检查蒸汽爆裂声（组织中100°C）和血栓形成（血液中80°C）的发生来评估安全性。

结果

计算出的热损伤与文献中的实验数据（尤其是体内研究）非常吻合。与标准设置相比，HPSD产生的病灶更浅，更宽，尤其是在导管处于45°的情况下。不管导管的方向如何，使用HPSD都会较早发生蒸汽爆裂。

结论

在需要浅而广泛的病变的情况下，尤其是当导管处于0°或45°时（如用于肺静脉隔离），HPSD似乎更为有效。